Provider Demographics
NPI:1598127284
Name:BRACKEN, RICHARD HAROLD II (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:HAROLD
Last Name:BRACKEN
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22025 HAWTHORNE BLVD # 1029
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7006
Mailing Address - Country:US
Mailing Address - Phone:614-946-2223
Mailing Address - Fax:
Practice Address - Street 1:2900 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5102
Practice Address - Country:US
Practice Address - Phone:323-325-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15847207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine